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New Email ID Request

Date: - / / .

___________ ___________ ______________ _____________


First Name Middle Name Last Name Employee Code.

__________ ________ ______________


Department Location Request Type
(New or Change)

__________________________________________________.
Requested E-Mail ID (e.g. Firstname.lastname@emerson.com)
(Note: Email ID would be differ in case of Email ID already exist)

Signature:- __________ _________________ _______________

Name: - __________ _________________ _______________


Requestor Immediate Supervisor Department Head

________________________________________________________________________

For IT Department Use Only

___________________ _____________________________________
Approved by with Date Implemented and communicated by with date.

Note: The Filled and properly signed form should sent IT department at HO
Zone\Branch users Fax no 25828358 or 25800829 with Atten IT department.

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